Patient Identifier

Please do not put your name. Use the unique identifier that was put in your email.

About how many sessions did you (and your partner, if applicable) attend?

If other, please specify.

When you first started treatment, how much progress did you expect to make towards your treatment goals?

How much improvement do you think you actually made towards your treatment goals?

What explanation BEST fits why you stopped attending therapy.

I felt respected, understood, and supported by my therapist even when I was challenged.

What barriers have impacted your treatment progress? Select all that apply.

If other, please specify

I could openly express my thoughts in session.

I would recommend Dr. Perry to others.

My therapist was professional.

My therapist seemed competent.

My therapist seemed to give me honest feedback about my problems.

My therapist used humor appropriately.

My therapist's billing procedures and practices were fair.

Any additional feedback you would like to share?